Nearly 84 million Medicaid members are having their Medicaid eligibility redetermined starting in April as the Medicaid continuous enrollment provision unwinds. Yet many of these members are unaware they could face loss of coverage.
At a time when consumers increasingly want digital self-service options and expect easy, intuitive and personal interactions with their health plan, many Medicaid plans still struggle with member engagement. It’s especially challenging given the barriers Medicaid members often face in accessing, understanding and leveraging health information. Without an understanding of individual communication preferences or the social determinants of health (SDoH)-related barriers that prevent member engagement, Medicaid plans won’t be able to reach members on the brink of losing coverage. The resulting coverage losses are likely to disproportionately affect marginalized communities.
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Leah Dewey Leah Dewey is an experienced leader in population health, clinical strategy, product development, and value-based outcomes. As vice president of clinical and consumer engagement operations, she drives product value for Cotiviti’s Consumer Engagement and Population Health solutions. Leah is focused on improving healthcare outcomes by leveraging data and insights to drive closure in […]
Now, health plans must consider what it will take to reach Medicaid members and successfully gain their participation and trust in the redetermination process to avoid gaps in care and coverage.
The barriers to outreach
Medicaid plans were able to initiate redeterminations as soon as the continuous enrollment period ended on April 1. It won’t be an easy task given how much the volume of Medicaid enrollees surged during the pandemic, with 28.5% more people, or 20.2 million, enrolled in October 2022 versus February 2020.
According to the Department of Health and Human Services, 15 million Medicaid and Children’s Health Insurance Program (CHIP) enrollees could leave the programs following redetermination. But communicating this risk to members will be challenging for numerous reasons:
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- Some Medicaid members are difficult to locate. Housing insecurity is a substantial challenge for the Medicaid population, and some members have been difficult to locate due to a change in address. For health plans that face staffing issues, efforts to stay current with member contact information have been further thwarted by lack of resources.
- Language barriers may make it difficult for members to understand the process. When individuals with limited proficiency in English navigate redetermination, they are more likely to face administrative challenges that prevent them from completing the necessary steps on their own.
- Cultural barriers to communication can complicate engagement. The ways in which members make important decisions about their health vary by ethnicity or race. That’s why communicating with authenticity is crucial. One important step is to deliver communications in the language members understand best. Another is to begin communications with an understanding of the nuances of the member’s culture, race or background. One study of 14 state Medicaid programs found that just four tailor outreach strategies based on cultural or linguistic needs.
- Skepticism stemming from longstanding barriers to care gets in the way of trust. If a member faces socioeconomic hurdles to care access or is part of a group that has been treated poorly by health systems in the past, the member may be skeptical of the healthcare system as a whole.
As states prepare for these changes throughout the 12-month renewal period, Medicaid plans can take proactive measures to protect member populations in the redetermination process.
Making the redetermination period count
Beyond the immediate challenges of redetermination, understanding a health plan’s population and mobilizing cultural intelligence to influence health communication and member behavior could have a deep impact on health outcomes over the long term. Actions for strengthening Medicaid member engagement include the following.
- Develop a multichannel approach to member communications, taking member preferences into account. Calls and text messages might appeal to some members, but perhaps not to a member using a pay-by-the-minute plan, which is more common among a health plan’s most vulnerable members. According to a recent RISE survey, health plans delivered communications more evenly across different channels in 2022 compared to previous years, increasing usage of email while decreasing utilization of letters and phone calls. The most successful health plans deploy a variety of approaches to initiate and maintain contact with their hardest-to-reach populations, keeping personal preferences, cultural influences and generational attitudes around communication in mind.
- Take a whole-person approach to data—and use this information to drive member action. Look for opportunities to centralize and standardize data across programs. Then, augment this data with SDoH and apply data analytics—from risk stratification to predictive risk scoring—to develop a more complete picture of the member’s health status. This will help in developing personalized communications that are tailored to the member’s unique circumstances and needs, which is essential to engagement. For example, Community Health Plan of Washington uses population health management tools to capture SDoH data by aggregating electronic health records from its community health centers and even creating dozens of new codes to optimize the capture of patient needs. This enables the health plan to stratify its population based on gaps in care. From there, the health plan can craft more effective communications, use communication vehicles or approaches that are most likely to appeal to the member, and more effectively initiate and maintain contact with their hardest-to-reach populations.
Segmenting a health plan’s population also is crucial. It’s important to consider how members make decisions around their health, as well as how they engage with information across communication channels. Health plans must also determine how they can influence consumer decisions while maintaining members’ sense of choice.
- Keep messages simple. Messages should be simple, concrete, personalized and highly relatable. Messages that are too complex will either be ignored or forgotten. Plans should also repeat messages—across communication vehicles—to influence members to take action. For example, with Medicaid redeterminations looming, text messaging can help members retain coverage by urging them to update their contact information and respond to renewal requests. However, some members may initially distrust text-based communications. In these instances, a follow-up letter or email could smooth the path to engagement.
- Use culturally aware communications to communicate with empathy. Investing in cultural sensitivity training for frontline staff as well as the marketing team helps ensure communications are both authentic and empathetic. This is an essential step toward building trust with marginalized populations. Once trust is gained, the health plan’s ability to influence health behavior among members becomes stronger.
- Partner with state Medicaid agencies, community health centers and other local organizations to perform outreach. Relying on partner organizations to be the first point of contact, with a warm handoff to the health plan, positions Medicaid plans to initiate these discussions from a place of trust.
By investing in Medicaid member engagement, health plans can strengthen their ability to reach members for Medicaid redetermination while taking actions that yield better outcomes and improved financial performance.
Photo: Feodora Chiosea, Getty Images
Leah Dewey is an experienced leader in population health, clinical strategy, product development, and value-based outcomes. As vice president of clinical and consumer engagement operations, she drives product value for Cotiviti’s Consumer Engagement and Population Health solutions. Leah is focused on improving healthcare outcomes by leveraging data and insights to drive closure in care gaps, improve consumer quality, and move population health across various cohorts and cultures.
